ASCT for CNS lymphoma – pro
Primary central nervous system lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma. A recent review by Alnahhas et al found looked at 1517 references and included 43 studies. ASCT was used as consolidative treatment or as salvage treatment/at relapse. Thiotepa, busulfan, and cyclophosphamide and carmustine/thiotepa were commonly used conditioning regimens. In the consolidation setting, 94% of patients experienced or maintained complete or partial response after ASCT. The rates of overall survival (OS) and progression-free survival (PFS) were 94%, 86%, 82%, and 70% and 79%, 70%, 64%, and 54% after 1, 2, 3, and 5 years, respectively. The overall risk of relapse at 5 years was 24%. In the salvage/relapse settings, 85% of patients experienced or maintained complete response or partial response after ASCT. The rates of OS and PFS were 75%, 63%, 56%, and 54% and 85%, 62%, 59%, and 54% after 1, 2, 3, and 5 years, respectively. The risk of relapse at 5 years was 29%. Subgroup analysis showed that the use of carmustine and thiotepa as a conditioning regimen carried the lowest risk of transplant-related mortality. The thiotepa, busulfan, and cyclophosphamide regimen, on the other hand, showed numerically superior OS and PFS rates. NCCN concludes that, whether there had been or not been confirmed complete response, “consider high-dose chemotherapy with stem cell transplantation”. As such, the proposed transplant is medically necessary
Alnahhas I, Jawish M, Alsawas M, Zukas A, Prokop L, Murad MH, Malkin M. Autologous Stem-Cell Transplantation for Primary Central Nervous System Lymphoma: Systematic Review and Meta-analysis. Clin Lymphoma Myeloma Leuk. 2019 Mar;19(3): e129-e141. doi: 10.1016/j.clml.2018.11.018. Epub 2018 Nov 24. PMID: 30584023.
NCCN CNS Lymphoma PCNS-2
irey O, Shargian-Alon L, Siegal T: Consolidation Treatment for Primary Central Nervous System Lymphoma: Which Modality for Whom? Acta Haematol 2021; 144:389-402.